PPPSS News & Events

Grief and Life Stress Postpartum: Where Does Postpartum Depression End?

A previous Pacific Post Partum Support Society client shares her story of postpartum anxiety and the grief of losing some of the people closest to her. She asks the important question: Where does postpartum depression and anxiety end and regular life stress begin. Her answer is insightful and so important.

Something I have struggled with, and am struggling with again with the birth of my second child, is knowing the difference between postpartum depression and anxiety versus regular life stress. I clearly remember when I first started thinking about leaving the support group at Pacific Post Partum Support Society. I had joined over a year before (mid 2012), and I had been given a list of questions to help me think it through, but it was not until winter break (late 2013)  that I got to test how I was on my own and confirmed that I was ready. However, I never really understood how I knew and more importantly, how I learned to recognize life stress outside of the framework of being a mother.

The circumstances surrounding my second child and the following postpartum period were quite different. I lost my mother only a year before we got pregnant, and as excited I was about the baby, every day got harder and harder without my mother. Add to that medical complications that led to a planned C-section (how ironic they called it planned when my entire birth plan consisted of one line: please do not cut me open) and a slew of other events including the death of my eldest brother just a month after my daughter’s birth. It really is no wonder that I now find myself asking, “how much of this is PPD/A and how much of this is just really crummy circumstances compiling?” I mean, any person would be fairly rattled after so much grief.

So after some soul searching and listening to the wisdom of the strong women around me in my group with PPPSS, I think I am finally close to an answer. Life stress and PPD/A symptoms do not exist independently of one another. They are intertwined; they work in tandem in how they affect our mood. PPD/A is like giving the stress of life a megaphone: it amplifies the stressors of our lives and it is LOUD. This does not take away from just how real and serious PPD/A is. You could be living your ideal life and still suffer from PPD/A, but we all have things we worry about or things that bring us down. PPD/A intensifies those feelings so when things go wrong or life throws us curve balls, they feel that much bigger.

So here you are with the critical voice of PPD/A screaming at you, and you are suffering.  What can you do? This is the time that it is the most important to practice compassion, kindness, and self-care. Sometimes PPD/A  is so loud you cannot even remember what you used to enjoy. That’s alright. It is a starting point. Self-care can take a variety of forms and the first step can be as simple as taking a single intentional breath. The second step, in my experience, is to get help. Build your support network and make it vast and strong. There is no shame in needing other people. Every part of our lives is based on our ability to rely on other people. If you buy groceries, live in a home that you did not build with your own two hands, or use running water from pipes you did not connect yourself, you have already relied on others. We are taught to value independence at the cost of the support available. But we do not have to do this alone. By choosing people who can support us during difficult times, we can take that megaphone away from PPD/A.  And even if we cannot completely take it away, the support of other people puts some distance between PPD/A  and us. Making ourselves a priority for care and buffering ourselves with the support of others can make the screaming of PPD/A a little less loud. The more we practice this, the softer the screaming gets until it becomes the life stress we knew before PPD/A. So it is not really about getting rid of the stress, but learning to take its power away.

Preparing for Motherhood After PPD/A

A few weeks ago we shared a story by Liz Lian about having a second child after experiencing postpartum depression and anxiety. This week we have another take on that theme by Kelley Allen. Kelley has graciously agreed to share the story of her pregnancy journey with her second child. This will be the first in an ongoing series about her preparations and experiences.

Article by Kelley Allen

I am 14 weeks along with my second child after experiencing postpartum depression and anxiety with my first. It took my husband and I quite a while to get to the point of even considering the possibility of another baby. Once we both felt like we were ready, we were lucky to find out I was pregnant pretty quickly. With my first, I was very, very sick for the duration of the pregnancy. My nausea and sickness took over and I barely functioned. I was prepared to experience the same this time around, but so far have been feeling pretty good. I do have low-grade nausea but it is nothing compared to my first pregnancy. For this, I am so grateful. I have no idea how I would cope with the sickness and fatigue while also caring for a 3 year old. I feel blessed to write that my mood has remained good so far in the pregnancy. There are hard days, tiring, irritable days, and I see my patience running thin with my daughter, but so far it feels manageable.

I have been reading Karen Kleiman’s book “What am I thinking? Having a Baby After Postpartum Depression” – which I highly recommend to anyone considering another child after PPD/A. I recently finished a section on anxiety, which was my biggest struggle after the birth of my daughter. Kleiman states “Will you get anxious again? Unequivocally yes. You will. Most definitely. Anxiety and motherhood go hand in hand. Accepting a certain amount of anxiety is not only a healthy response, it provides you with the tools to cope. If the anxiety becomes excessive, that is, if it interferes with your ability to experience pleasure or becomes the focus of your day, then that’s too much anxiety and that is no longer okay. This is when you need to follow up with a professional.” What resonates with me about this is how Kleiman doesn’t sugar coat it. She doesn’t suggest that this time around everything will be wonderful. She keeps things very realistic. This time around, it won’t be a breeze. Adjusting to a new baby and such a huge change will always bring difficulties. Recognizing that, and giving myself permission to experience a certain degree of depression and anxiety feels comforting. The key will be to know what to do if/when it becomes excessive.

 
I keep reading and hearing from everyone that I need to have a plan. Although it is early on, I have started to develop one. I have connected with Reproductive Mental Health with BC Women’s Hospital, who will follow me throughout pregnancy and for a year after birth. I have reconnected with my counselor, and I have decided to remain on a safe medication for my pregnancy.  I had lunch with a friend yesterday who recommended looking into postpartum doula services and meal preparation/delivery services. We live in Vancouver with no family nearby, so I am working to line up as much help as I can. My hope is that I line up many services and in the end don’t need to utilize them. I am trying to be realistic about how much work another baby is going to be, on top of a preschooler, assuming I feel like myself. If I experience PPD/A again, I will definitely need the help. I am okay recognizing and admitting this. My first experience of PPD/A helped me to see that it isn’t about pride, or some sort of weakness in asking for help. It is about taking care of myself and in doing so, taking care of my family.

Infant Illness and Postpartum Anxiety

Ashlee shares her story of postpartum anxiety triggered by the traumatic experience of having a sick infant. Trauma during or after birth are highly correlated to postpartum depression and anxiety in the months that follow. See the link at the bottom of the article for more information about the signs and symptoms of postpartum anxiety and how it differs from depression.

Article by Ashlee Turner

The much anticipated arrival of my second son was an empowering natural birth, but the moment that will be burned into my mind forever is pulling my son up, looking at his sweet newborn face, and the absolute silence of a room full of doctors, nurses and my husband- the complete silence as everyone held their breath waiting for my son to take his first. And then the whirlwind of activity as he was grabbed, wet, new and purple off my chest and resuscitated. Straining, trying to watch what was happening from across the room as a separate team of doctors worked on stopping a postpartum hemorrhage. But he breathed, and he screamed, and he was laid on my chest and I nursed him, and kissed his bruised, beautiful head and pushed the thoughts of almost losing my baby boy out of mine. I thought that would be be the story I would tell about his harrowing entrance into the world. A healthy beautiful boy, and the longest moment of my life, waiting to hear his little voice for the first time.

What I didn’t know was three and a half weeks later I’d be back in that same hospital, holding my breath in room in a filled with doctors and nurses, this time not waiting desperate to hear his cry but instead wishing with everything in my body that I never had to hear the screams of pain coming from his tiny body. Sepsis is not something most parents of healthy, term babies think much about. A systemic infection of that level in an otherwise healthy infant is rare. But there we were, watching failed blood draws, tourniquets bruising arms and and legs, head shaved, IV lines in his scalp, spinal fluid dripping into vials from his back. It is a horrifying image and I one I was not prepared for. I’d taken home a healthy baby. But for 11 days I waited. It seemed with every piece of good news, came bad. A clear spinal culture, followed by the discovery of a heart murmur. A good day followed by a night he could not be woken. It was terrifying. The survival rate for a baby so young with sepsis, I was told can be as low as 60%. Much of my life became a mental numbers game. The almost incalculably slim odds of having a baby contract sepsis from a blocked tear duct were minuscule. The odds of survival in comparison were dismal. I was completely focused on sitting in a chair all day, rocking and feeding my child. Studies showed babies who were held skin to skin the most had a higher chance of recovery. I obsessed over tiny details, like the battery left on his pump, a bend in his tubing or the tape on his bandages. I dutifully dripped sucrose drops into his mouth during his PICC line placement and many painful tests. I desperately missed my two year old son who was at home with my husband most days. I felt like I was abandoning him. I felt like I was a terrible mother. Was there something I could have done differently to have prevented this? What could I be doing to make him get better faster? How could I be abandoning my older son like this when he needed me too?

When my new baby got his clean bill of heath and headed home, I thought things would be better. Still, a dark cloud of panic stayed over me. I obsessed over watching his breathing. I was terrified the chemicals in soap and the environment might poison him. Every time my cheek rested against the prickly stubble of my baby’s shaved head I would burst into uncontrollable tears. I was completely focused on my two boys, constantly terrified something would happen. At the same time, I felt incompetent. Helpless. Like there was nothing I could do to protect them from the world. I loved them, I wanted to protect them but I constantly believed I would fail them. Constantly calculating the odds. I wondered if I had postpartum depression, but this was different from what I’d been told to watch out for. I knew that  sadness that seemed to last and worsen, and feeling distanced from my baby would be reason to see my doctor. I knew that from every prenatal checkup and brochure from the hospital. That was the thing though, I felt connected to my baby. I loved him, I felt an intense need to protect him… but everything made me scared. Everything made me panic. I was anxious. I was terrified of everything. I ended up reading about postpartum anxiety  when I saw it mentioned on a forum, and I realized what I was feeling wasn’t normal. It was affecting me, my husband, and my children. I’d never heard of postpartum anxiety before, but soon I started to wonder if this thing I’d never heard of was happening to me. I spoke to a public health nurse. She told me that anxiety in parents of children who have been seriously ill is not uncommon. I talked to my family. I tried to find ways to cope. Some days went well. Other days I felt too stressed, scared and too incompetent to leave the house.

I chose to pursue healing without medication. It was not easy. Sometimes dealing with everyday things filled me with crippling fear and it seemed too difficult to even think about. But I have a loving husband, and two gorgeous boys- something I reminded myself of everyday. I started exercising, focusing on the good days- the “wins “, and eventually those good days became far more prevalent than the bad ones. My son is now five months old, and it has been about four months since he became ill. I would love to say that my anxiety is gone, and that I don’t still wake up in the middle of the night and panic, or have days when I feel helpless. The truth is I know I still suffer from anxiety. It isn’t something that gets cured overnight, there is no quick fix. I can say though, that those bad days are few and far between. These days I am able to enjoy my two sons without feeling paralyzed with guilt, fear and uncertainty. I can take them to the park without being afraid something will happen to them, or feeling like I can’t do it alone. Postpartum anxiety is a part of my parenting journey, but it’s just one part. It doesn’t define me as a mother. We are surviving this part of our journey, like we have survived all the other parts before it. One step at a time. When I am with my sons, the only thing I can guarantee is that no matter how difficult those steps are, they are worth it.

Ashlee Turner lives on the east coast of Canada with her husband and two sons. She is a full time mother, part time library tech who is passionate about attachment parenting, and is a breastfeeding, bed-sharing and baby-wearing advocate.

One of the many reasons for delaying treatment of postpartum depression and anxiety is a sense that you don’t fit the definition of a perinatal mood disorder. It’s important to remember that postpartum illness can involve symptoms other than depression. Anxiety is one of the most common. Postpartum Progress has an excellent article about the symptoms of postpartum depression, anxiety, and obsessive compulsive disorder. Parents (birthing or otherwise) may not feel depressed or disconnected from their children, but they may still be suffering from a postpartum mood disorder. Education is key. The faster symptoms are recognized and addressed the better the outcome is for recovery.

The Mother I Wanted to Be: Having a Second Child after Postpartum Depression

Liz shares her story of postpartum depression and how she created a different experience for herself with her second child. Her story illustrates how creating intentional supports and community can transform the postpartum experience, even when a person has experienced postpartum depression in a previous pregnancy.

Article by Liz Lian

I always thought I’d make a decent mom. At thirty-five I had already survived sleepless nights to graduate from MIT, had persevered as a consultant under grueling conditions and had happily immersed myself in the new and unfamiliar while living abroad. Over evenings and weekends my husband and I fit in birth preparation and newborn care classes. We wrote up a birth plan.

My first two weeks as a new mom left me utterly devastated. I had never felt so alone, so overwhelmed. I had no local mom friends, no close family nearby. I dreamt of catching a one-way flight to some small Ohio town and restarting my life where no one knew me. When my husband walked out our front door to return to work, I wept for an hour at the breakfast table. Cradling my precious daughter, I sobbed for her and her broken mother who, usually so strong, independent and competent, felt barely capable of mothering. I was going through the daily motions, scraping myself together to try and be a good mother. On the inside, I was falling apart.

It took me years to unpack my postpartum hell. Yeshi’s New Mother’s Circle, a facilitated group for new moms, was the first space where sharing my suffering felt safe. We held our babes as we each tearily shared our own versions of ‘I never thought this would be so hard!’, or ‘I wanted to escape.’  or ‘I thought motherhood would complete me, why do I feel so alone?’

One morning, seven months in, ongoing insomnia of three to four hours’ sleep each night brought me to my breaking point; I was unable to will myself out of bed. My thoughts turned to escape again. I couldn’t bear the thought of my daughter growing up without her mother and actively began seeking help. My doctor diagnosed postpartum depression and prescribed anti-depressants. I worried that anti-depressants would bury my feelings. I wanted to face the demons that drove my sleeplessness, preventing me from becoming the mother I wanted to be.

I began weekly therapy and joined my husband in couples therapy. I started journaling. I explored the raw feelings keeping me awake at night – the loss of my former capable self, abandonment by my husband and mother, anger at family and friends who did not meet my expectations of support, frustration with my body for taking so long to heal. Slowly, with a better understanding of myself and with the willing engagement of my husband and my mother, I learned to let go of expectations and live more fully in the present, to draw boundaries and care for myself, and to communicate from the heart and heal my close relationships. For two years, even as I began to feel more like myself, I was too terrified to consider another baby. I did not want to risk descending again into the dark pit of postpartum loneliness and despair.

When I was finally mentally ready to try for a second child, I resolved to build community and support into my next postpartum experience. After learning I was pregnant, I scaled back my work life and prioritized caring for myself and my family. I met with Maria, a highly respected local midwife. Our hour long prenatal visits gave me time to delve into my birth and postpartum intentions, as well as postpartum fears and anger that unexpectedly emerged. Maria gently reassured me it was normal to see post traumatic stress symptoms during the postpartum period. I reconnected with my therapists to work through re-emerging painful emotions. Their knowledge of the details from my first postpartum journey helped me recall what worked, what didn’t and what we should celebrate. Once I decided a postpartum doula was worth the investment, Maria recommended Esther, a veteran doula with relevant experience who could help me navigate the vulnerable first couple weeks.

I never made a birth plan; instead, I created a family postpartum plan. The process of conversing with family and friends to set realistic expectations of support was invaluable. For example, taking the time to clarify that my most important criteria for our initial week of support were food preparation, ability to figure out what needed to be done and entertaining our four-year-old helped me identify the family member best able to help us immediately after the birth. To ensure I had a safe peer space, I organized a facilitated second-time mom’s group.

My younger daughter was born to a mother who was nurtured, emotionally supported and empowered. The first week, I rarely left my bedroom, spending 24/7 in bed with my babe, welcoming visitors to my bedside. I especially cherished the beautiful, natural rhythm my daughter and I shared. When she slept, I slept. When she woke, I nursed and chose among the ample, nutritional snacks by my bedside. I kept my tank full, knowing there could be sleepless nights to come. As I faced the inevitable challenges along the way, I met them with an equanimity and a positive, I-can-overcome-this attitude. I knew I was able to count on my intentional community for guidance and support. In the first weeks my support team helped me overcome mastitis, PUPPP (a horrible postpartum itchiness all over my body), relationship friction and several months later, an unexpected international move.


The second time around, I was stunned to discover motherhood could be so magical. I was a joyful mother, filled with gratitude. The loneliness, the despair, the exhaustion I had previously known as a new mother had been banished.  They were replaced by a sense of community, of peace, of wholeness. I had become the mother I wanted to be.

 

Liz Lian lives in Switzerland with her husband and two daughters. When she is not exploring Swiss life with her family, she writes about motherhood, relationships and education.

The Things that are Lost

Part 4 of our August Self Care Series focuses on those things you used to love that are now impossible, or seem that way, after having a baby. How can we cope with the loss of things that used to bring us joy?

Article by Andrea Paterson

We all know that pregnancy, birthing, and motherhood require sacrifice. In some way we prepare ourselves for the changes our bodies undergo, for the sleepless nights, for the morning sickness, for the inability to leave the house because of intense nursing schedules. Or at least we know these things are coming, even if we can’t be prepared for just how difficult it will all be. We are warned about some sacrifices, but others come as a complete surprise and blind-side us.

I play the violin. Or at least I did. I did play the violin before my son was born. I used to go out to Irish Fiddle Sessions in the city, I used to take lessons, I’ve played in some bands,  I used to play at home with my husband playing guitar along with me. This was a form of self-care that was in my blood. My playing has ebbed and flowed over time but it has been something I’ve come back to again and again. The Irish reels and Scottish strathspeys speak to me. Shortly before my son was born I found the perfect violin. I had been casually looking for a new instrument for years, picking up random fiddles in stores and testing them against the sound in my head. I was looking for something that resonated with me, that sounded like my own voice transformed into a bow drawn across strings. My husband went to a music store one day looking for a ukulele. I went with him and idly picked up a violin. I instantly knew that I had found it. I found the violin that matched my soul. I found the instrument that was my own voice set free. My heart skipped. I looked at the price tag and gasped a little. But there was no leaving the store without it. As I walked out of the shop a salesman said “I hope that instrument will give voice to your greatest joy and your deepest sorrows.” I took it home, reels and jigs already thrumming in the wood, my hands itching to play. As I said, I had my son soon after, and that lovely perfect violin has sat dormant for the majority of the days since.

It’s not because I didn’t have time. And it’s not because I was too tired. Motherhood wasn’t the problem exactly, it’s just that my particular child hated the violin. When he was little the volume of the instrument disturbed him. I couldn’t play when he was sleeping because it would wake him up. As he got older I tried to play while he was awake, but taking up the bow and launching into a tune would send my child into hysterics. He clung to my leg, he cried, he screamed. Once he could talk he started shouting at me to put it away. He howled. Sometimes I tried to play over the caterwauling but who can enjoy music with a sobbing child punching your leg and begging you to stop? I don’t know what bothered him so much. I suspect it was more about the fact that I wasn’t paying direct attention to him and less about my playing (I hope).

But central to all this was the loss of a go-to method of self-care. Sometimes having a child means that you really and truly can’t do the things that feed you in the moments you need them most. I suspect that many new mothers, when charged with the directive to practice self-care, find themselves in similar situations–the presence of a new baby rules out the possibility of engaging in the things that used to matter most. Maybe the birth did physical damage that leaves a mother unable to play a sport she used to love, maybe round the clock nursing is keeping a mother from playing late night gigs with her band, maybe depression and sleep deprivation keep a new mother from having the focus and dexterity required to paint or sculpt. Feeling like you no longer have access to the things you loved most can be devastating. It can lead to resentment and anger and these are normal responses to a deep loss. So what can be done?

First, know that the loss of your most cherished activity is likely temporary. As you heal from birthing and your child grows older and more independent you may be able to engage in those lost outlets again. In the meantime you need to find a way to fill the hole. Is there a way to practice a related activity? If you can’t play ultimate frisbee due to an injury can you do something less physically intense? Could you temporarily take up cycling or swimming until you’re strong enough to go back to the sport you love? If you don’t have the attention span for detailed artwork, could you find quick but satisfying projects that will tide you over? You may not have the time or ability to work for hours on a detailed water-colour, but could you do some quick sketches or gesture drawings? The period after the birth of a child may be a time for poetry rather than novel writing. It’s a time to connect with what you love in fits and starts. You may not be able to luxuriate in two hours of yoga, but maybe you can fit in fifteen minutes.

So what if you can’t practice your favourite hobby at all? On an old  episode of the podcast the Longest Shortest Time a woman discussed her love of singing and how her voice was bizarrely altered by pregnancy. After giving birth she found that she literally couldn’t sing anymore. Something in her body had changed and her voice was lost. I suspect that other women have experienced strange and devastating effects of pregnancy and childbirth. The unpredictability of it all may mean that the hobby you loved is truly not available to  you. This is a deep and upsetting loss. A mother may feel that her baby has taken her sense of self. Something integral has been stolen and feelings of grief and rage are not out of place. Leave space for those feelings. Let them breathe. See if there are other areas of the self that could be developed or renewed. Maybe you used to knit–is that something you could take up again? Fiber crafts are excellent to do with kids around because you can work on them for minutes at a time and easily set them aside for later. Maybe you’ve always wanted try Zen meditation, the loss of your primary hobby might be the push you need to try something new.

Motherhood sometimes calls us to redefine ourselves. It isn’t easy, and it isn’t painless, but there can be small gifts buried in the process–maybe a chance to read more or journal more, listen to more of your favourite podcasts or learn to bake bread from scratch. There are small and fulfilling things that can fit into your day if you can only strike out and find them. Don’t give up hope on the things you loved most, but be brave enough to set them aside for awhile. Know that they’ll be waiting, or that you’ll stumble upon something equally wonderful that will buoy up your spirit.

Recently I tried pulling out my violin yet again. My son is three and a half. Maybe, just maybe, he would let me play without theatrics. I asked if he wanted to play along (he has a collection of instruments including a small keyboard, rattles, and bongo drums). At first he said no. I began to play and he began to get angry. “Look,” I said. “I just need fifteen minutes to play. Why don’t you go upstairs if the sound is bothering you. You can play in your room.” My son stomped up the stairs, glaring at me all the way. I anxiously started in on an old Scottish air. I listened for sounds of protest from upstairs. None came. I played a little more. Then I saw an inquisitive head poking around the corner. My boy came into the living room with a kazoo in hand. “Can I play too?” he asked. “Of course!” I said, and he began to wildly play his kazoo. His music was random and loud and completely unrelated to the tune I was playing. He kazoo’ed along with gusto. Somehow he always managed to match the very last note of the tune but not a single other note of the melody. It was fine. We were having fun. He insisted on being able to see the music on my stand. He stood on a chair and flipped the pages of my music book to choose the next piece. My son let me play the violin, albeit with insane kazoo accompaniment, for over twenty minutes. It’s a start, and I’ll take it.

There will be a return to the things you love, in time. And if there cannot be, for whatever reason, you will find new loves, new things to sustain you. It’s hard to focus on the space and opportunity opened up by a loss, but it’s there and it’s possible to embrace it. Acts of self-care are not optional, they are essential to survival. If you have lost your way, a new path must be forged. Maybe it’s time to take up the art of paper making. Maybe it’s time to start jogging. Maybe it’s time to get that membership at your local art gallery. Listen deeply to your heart and see if there is something new calling you. I think you’ll find that not everything is lost after all.